Anemic Drugs Flashcards
conditions associated with normocytic, microcytic, and macrocytic RBCs
normocytic RBC - acute blood loss
microcytic - iron deficiency anemia
macrocytic - B12 or folic acid deficiency
causes of iron deficiency
acute or chronic blood loss
insufficient intake esp in kids
heavily menstruating or preggo women
type of anemia from iron deficiency
hypochromic, microcytic anemia
oral iron therapy
ferrous sulfate
ferrous gluconate
ferrous fumurate
adverse effects of oral iron therapy
nausea epigastric discomfort abdominal cramps constipation diarrhea
black stool (no significance other than may obscure diagnosis of continued GI blood loss)
what are parenteral iron therapy and when is it given
iron dextran, sodium ferric gluconate complex, iron sucrose
given to those who are unable to absorb or tolerate oral iron and extensive chronic anemia that cannot be maintained with oral iron alone
when is acute iron toxicity usually seen
in children who accidentally swallow iron tablets and it is a medical emergency
what do kids with acute iron toxicity experience as in what are their symptoms
necrotizing gastreoenteritis, vomiting, abdominal pain, blood diarrhea
can be followed by shock, metabolic acidosis, coma, and death
how do you treat acute iron toxicity
- whole bowel irrigation to flush out iron
- Deferoxamine, an iron chelator, can systemically bind iron that has already been absorbed and get rid of it in urine or feces
another name for chronic iron toxicity and what is it
hemachromatosis and when excessive iron is deposited in the heart, liver, pancreas, and other organs
who is hemachromatosis mainly seen in
pts with inherited hemachromatosis
those who receive many red cell transfusions
drugs used in pts with thalassemia major to get rid of iron
iron chelators - deferoxamine and deferasirox
what does deficiency in vit B12 lead to
megaloblastic anemia
neurological symptoms
active form of vit B12 found in humans
deoxyadenosylcobalamin and methylcobalamin
forms of vit b12 found in foods that are converted to active form
cyanocobalamin, hydroxycobalamin, and other cobalamins
how long will it take to use up our storage of vit b12
5 years
relationship between vitamin B12 and folate
methylcobalamin (from vit B12) is an intermediate in transfer of methyl group from N5-methyltetrahydrofolate to homocysteine in order to form methionine and tetrahydrofolate (dTMP)
without vit B12, you have a build up of homocysteine and lack of tetrahydrofolate (needed for DNA synthesis)
called methylfolate trap
what happens when you have lack of tetrahydrofolate due to lack of Vit B12 and what is treatment
- lack of tetrahydrofolate means reduced DNA synthesis
- give folic acid to tx the anemia
what leads to neurological symptoms in vit B12 deficiency
vit b12 is needed to convert methylmalonyl CoA to succinyl coA by methylmalonyl coA mutase so without it, you have a build up of methylmalonyl coA which accumulates as methymalonic acid which causes neurological problems
characteristic manifestation of Vit B12 deficiency
- megaloblastic, macrocytic anemia
- mild or moderate leukopenia/thrombocytopenia
- hypercellular bone marrow
- accumulation of megaloblastic erythroids
- parasthesia in peripheral nerves
- ataxia and other CNS problems
if megaloblastic anemia is diagnosed, why must it be determined if it is due to vit B12 or folic acid deficiency
- treating with folic acid will reverse the hematological problems but the neurological symptoms of vit B12 will continue to get more severe
common causes of vit b12 deficiency
- pernicious anemia (no secretion of intrinsic factor by gastric mucosal cells)
- partial or total gastrectomy
- conditions that affect distal ileum
what are the parenteral injections given for vit b12 deficiency and for how long
cyanocobalamin and hydroxocobalamin
for life if due to pernicious anemia especially
drugs that cause folate acid deficiency
methotrexate
phenytoin
trimethoprim and pyrimethamine
high risk patients that require folate supplementation
pregnant women alcoholics hemolytic anemia liver disease certain skin disease pts on renal dialysis
what are the hematopoietic growth factors
FrIEDS Filgastrim Interleukin 11 Erythropoietin Darbepoetin Sargramostim
where is endogenous erythropoietin produced and what happens with it during tissue hypoxia
- produced in the kidney
- increased transcription of erythropoietin in response to hypoxia hence correcting anemia
relationship between hematocrit/hemoglobin levels and erythropoietin normally and in anemia of chronic renal failure
- normally if hematocrit or hemoglobin levels are high then erythropoietin levels are low and vice versa
- in those with anemia of chronic renal failure, erythropoietin levels are usually low because kidney is not able to produce it so they benefit from exogenous erythropoietin
what is darbepoetin and how does it differ from erythropoietin
long acting version of erythropoietin that differs by an addition of two carb chain which improves it biological activity
it has decreased clearance and half life that is three times that of erythropoietin
adverse effects of erythropoietin
hypertension
thrombotic complications
what are the growth factors and what do they do
filgastrim (G-CSF –> granulocyte colony stimulating factor)
sargramostim (GM-CSF –> granulocyte-macrophage colony stimulating factor)
they both stimulate the production and function of neutrophils
GM-CSF stimulates production of myeloid and other megakaryocyte progenitors
have receptors that are part of JAK-STAT pathway
erythropoietin
filgastrim
sargramostim
what is filgastrim and sargramostim used for
accelerate recovery of neutrophil after cancer therapy and to treat other form of neutropenia
what is erythropoietin used for
anemia in renal failure but also anemia of other forms
adverse effects of filgastrim and sagrasmostim
G-CSF - bone pain
GM-CSF - fever, arthralgias, capillary damage with edema
what does interleukin-11 do and what is it used to treat
stimulates growth of primitive megakaryocyte progenitors and increase number of peripheral platelets
used for patients with prior episodes of thrombocytopenia after a cycle of cancer chemo so they don’t have to get platelet transfusions
used to treat sickle cell anemia
hydroxyurea
what does hydroxyurea do
it increases the amount of fetal hemoglobin therefore diluting the amount of abnormal hemoglobin S (HbS)
side effects of hydroxyurea
bone marrow suppression and cutaneous vasculitis
what is hydroxyurea used to treat other than sickle cell
chronic myelogenous leukemia (CML)
polycythemia vera
